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目的:分析不同阶段2型糖尿病肾病(DN)患者合并糖尿病慢性并发症的发生率。方法:临床或肾活检确诊的2型DN患者774例,根据尿蛋白及血清肌酐水平分为白蛋白尿期、临床蛋白尿期及血清肌酐升高期,分析不同时期患者并发症的发生率及代谢指标差异。结果:774例DN患者平均年龄(56.6±11.3)岁,糖尿病病程中位时间为96个月,肾病病程中位时间为12个月。白蛋白尿者210例,蛋白尿者246例,肾功能不全者318例。DN患者视网膜病变的发生率随病程进展逐渐上升,肾功能不全者较肾功能正常者升高显著;周围神经病变占49.5%,以浅感觉障碍为主,自主神经病变以胃肠功能紊乱、性功能障碍最多见,肾功能不全的患者大部分出现神经病变;各期DN患者心绞痛和心肌梗死的发生率无明显差异,肾功能不全者心肌缺血的发生率明显升高,达40.3%;DN患者随病程进展,心肌舒张功能逐渐下降;脑血管病变中以缺血性脑血管病变为主;糖尿病足的发生率较低(1.4%),间歇性跛行达7.5%;80.6%DN患者存在高血压,以肾功能不全者尤著;白蛋白尿组患者糖化血红蛋白达标率明显高于蛋白尿组及肾功能不全组,与蛋白尿组比较达统计学差异;白蛋白尿组患者的空腹及餐后血糖均较后两组患者控制更好;DN患者脂质代谢异常以三酰甘油和低密度脂蛋白升高为主。结论:2型DN患者同时存在糖尿病其它大小血管并发症,肾功能损害严重者,并发症多且严重。视网膜病变不能作为DN早期诊断的必备条件;神经病变的发生率亦随病程进展呈明显上升趋势,并进一步促进疾病的进展;随着DN的进展,心肌缺血比例增加,心肌舒张功能下降,可能增加DN患者心血管的死亡率。我国DN患者代谢控制达标率低,因此,强调DN患者综合治疗是改善患者远期预后,减少并发症,提高患者生活质量的关键。
Objective: To analyze the incidence of chronic complications associated with diabetes in patients with type 2 diabetic nephropathy (DN) in different stages. Methods: A total of 774 DN patients diagnosed by clinical or renal biopsy were divided into albuminuria, clinical proteinuria and elevated serum creatinine according to urinary protein and serum creatinine levels, and the incidence of complications in different periods and Metabolic differences in indicators. Results: The average age of 774 DN patients was 56.6 ± 11.3 years. The median duration of diabetes was 96 months. The median duration of nephropathy was 12 months. 210 cases of albuminuria, 246 cases of proteinuria, 318 cases of renal dysfunction. The incidence of retinopathy in patients with DN gradually increased with progression, renal dysfunction than those with normal renal function increased significantly; peripheral neuropathy accounted for 49.5%, mainly to light perception disorder, autonomic neuropathy with gastrointestinal disorders, sexual function The most common obstacle, renal insufficiency in most patients with neuropathy; angina and myocardial infarction in patients with no significant difference in the incidence of DN, renal insufficiency were significantly increased myocardial ischemia, up to 40.3%; DN patients With the progress of the disease, myocardial diastolic function gradually decreased; cerebrovascular disease mainly ischemic cerebrovascular disease; diabetic foot incidence was low (1.4%), intermittent claudication reached 7.5%; 80.6% DN patients with hypertension , Especially renal insufficiency; albuminuria patients glycosylated hemoglobin compliance rate was significantly higher than proteinuria group and renal insufficiency group, and proteinuria group was statistically significant differences; albuminuria patients fasting and postprandial Blood glucose control were better than the latter two groups; DN patients with abnormal lipid metabolism to triglyceride and low-density lipoprotein-based. Conclusion: Type 2 diabetic patients have other vascular complications of diabetes mellitus at the same time. Those with severe renal impairment have multiple and severe complications. Retinopathy can not be used as a prerequisite for the early diagnosis of DN; the incidence of neuropathy also showed a clear upward trend with the progress of the disease, and further promote the progress of the disease; with the progress of DN, increased myocardial ischemia, decreased myocardial diastolic function, May increase cardiovascular mortality in DN patients. Metabolic control in our country DN patients compliance rate is low, therefore, emphasizing the comprehensive treatment of patients with DN is to improve long-term prognosis of patients to reduce complications and improve the quality of life of patients is the key.